The Download: Matt Hancock’s tech legacy assessed

Ten days after Matt Hancock’s appointment as health secretary on 9 July 2018, he announced on Twitter that workforce, technology and prevention were his “early priorities”.

In the subsequent three years, it became clear that neither the workforce nor prevention agendas could match Mr Hancock’s passion for technology.

Since garnering headlines for endorsing Babylon’s GP at Hand app in his first speech as health secretary, Mr Hancock frequently sought to highlight the importance of the NHS embracing the tech revolution.

While his legacy will naturally be seen through the lens of covid-19, The Download could not resist comparing some of Mr Hancock’s visions for NHS tech at the start of his tenure with the state of the sector at the point of his abrupt departure.

The vision

During that first speech at West Suffolk Hospital on 20 July 2018, Mr Hancock said he wanted technology like Babylon’s app to be “available to all, not just a select few in a few areas of the country”.

In the ensuing few months, Mr Hancock pledged that “outdated and obstructive NHS IT systems will become a thing of the past”, with a promise to introduce minimum technical standards, modular and interoperable IT systems, and an end to “big contracts” for NHS IT services, with increased market share for smaller and specialist companies.

In early 2019, HSJ revealed Mr Hancock was seeking more control over the NHS tech strategy by establishing NHSX. Set up in the summer of that year, NHSX was tasked with aligning tech policy across the health service and developing a central strategy to guide local health systems towards a more joined-up digital transformation.

Later that year, Mr Hancock also announced the Digital Aspirant programme as the successor to the Global Digital Exemplar programme, and in doing so shifted the focus from improving tech at the best in class to those propping up the bottom of the digital maturity table.

The reality

If we briefly ignore the pandemic, changes to tech in the NHS — in the ways Mr Hancock envisaged — have not completely materialised, though some progress has been made.

Patients are continuing to turn to digital GP services. Livi UK’s achievement this month of becoming the first online primary care provider to be rated “outstanding” by the Care Quality Commission felt like a milestone for the sector.

However, providers like Babylon and Livi still face a long journey to become fully embedded in health systems across England, which is evidenced by the low number of NHS organisations that the companies have managed to formally agree partnerships with.

For all Mr Hancock’s talk about minimum standards and interoperable IT systems, the NHS is still far from this ambition. While efforts have been made to strengthen consistency of IT systems the NHS purchases through procurement frameworks, there is still much variety in what is being bought and how it works alongside other tech solutions. Perhaps this will only be truly addressed once proposed legislation in the new health and social care bill to enforce such standards comes into effect.

Meanwhile, research by HSJ Intelligence (subscription required) last year found trusts are still reliant on just a handful of tech companies for electronic patient records. Several trusts, such as Guy’s and St Thomas’ and Manchester, have also signed lengthy contracts that could only be described as “big”, which Mr Hancock previously indicated opposition to. The EPR market remains more a mixed salad of few ingredients than a melting pot of many merchants.

The Digital Aspirant programme can be described as a success in that it has provided funding — as promised — to dozens of trusts, which has improved their digital infrastructure. Some trusts have even used the money for more ambitious purposes, which Mr Hancock presumably would not be against. This autumn’s Spending Review may give further clues as to where the programme goes from here.

NHSX

Of all Mr Hancock’s policy decisions (pandemic aside), he will surely be most remembered for setting up NHSX. The unit has both fans and critics, but it has had a tough start to life. The pandemic hit Britain just nine months after the agency was created, which has delayed some of the strategies it was set up to design.

The decision to merge NHSX with NHS England’s new transformation directorate is hard to see as anything other than a weakening of its authority, and sources at the time told HSJ that Mr Hancock did not approve the move with much joy. NHSX, in its current form, will need to persuade Sajid Javid of its value if it is to have a long-term future.

Conclusion

Three years is not long enough for any secretary of state to deliver their ambition, particularly when tasked with transforming an organisation as large and complex as the NHS. But Mr Hancock’s enthusiasm for tech gave the sector a much-needed boost following several years in the shadows after the fallout from the National Programme for IT.

Of course, the NHS has made massive strides in adopting tech recently, but it is covid-19 — not Mr Hancock — which takes the credit for this. Among the greatest breakthroughs driven by the pandemic are the use of remote consultations, remote monitoring and increased data sharing between NHS organisations. 

It is somewhat ironic the pandemic has propelled the NHS far closer to Mr Hancock’s original vision, while also sparking the societal rules which — when breached — cost him his job.

Under Mr Hancock’s tenure, the NHS has taken a big step into the 21^st century, but — while the ex-health secretary talked a good game — it was the pandemic that sparked change in ways that Mr Hancock never could.